Rural poor in Tamil Nadu distrust govt healthcare facilities

More than 60% of the rural poor in Krishnagiri do not trust government medical facilities, citing poor treat ment, lack of resources and corruption, a study covering 26 clusters in the state has found.Ekatha Ann John | TNN | November 28, 2016, 07:25 IST

"prompt and easy physical access to healthcare facilities but also that they can also afford the treatment,"More than 60% of the rural poor in Krishnagiri do not trust government medical facilities, citing poor treatment, lack of resources and corruption, a study covering 26 clusters in the state has found.

Although the state scores high on most health indices, the study published in peer-reviewed journal Social Science and Medicine found that government facilities are not well perceived by people at the grassroots: Around 68% of the respondents said they would not consider seeking state healthcare services as they were “inappropriate“ and “corrupt“.Around 48% mentioned long queues, insufficient staff and lack of resources as reason for the same. Private hospitals, the alternative, were not a favourite either: Around 93% reported high treatment cost at these facilities.

The study , covering around 1,700 people in four panchayats -Anchetty , Thaggatti, Madakkal and Urigam -of Krishnagiri district, was undertaken by a team from University of Guelph, Canada.

Dr Warren Dodd, the lead author of the study , said the team chose Tamil Nadu because it topped the country on health parameters.

However, researchers found high prevalence of non-communicable and chronic diseases, with issues related to the limbs being the most pressing concern as at least 90% of the subjects surveyed hailed from historically marginalised castes and engaged in heavy manual labour. Dr Dodd said when these people were interviewed, it threw up a startling number: “Around 79% did not manage major illnesses with medical care unless it seriously affected their work,“ he said.

Researchers found that perception of inappropriate treatment and other barriers deter households from using public healthcare services. “For them, an efficient healthcare facility is one that facilitates the fastest return to work using the fewest resources,“ said Dr Dodd.

Although government facilities were the most common healthcare access point, long queues and limited hours pushed these people, despite high prevalence of poverty , to private clinics and hospitals.Respondents also reported that same treatment protocol was followed in all primary health centres regardless of diagnosis, which was perceived to be ineffective. “Despite prohibitive costs, private care was perceived to be superior to public healthcare, especially for diseases like diabetes,“ the study noted.

The options for the respondents weren't just limited to choosing between state and private facilities. The system lets quacks flourish. Dr Jeremy Denga, a physician practising at Periyampatti in Dharmapuri district, around 30km away from the study site, said there were at least half a dozen quacks for every qualified doctor at the village level. “They make themselves available round the clock and spend time with the patients and talk to them unlike doctors in the mostly crowded PHCs,“ he said.

S Elango, former director of public health and preventive medicine, said this mindset reflects the lack of health literacy at the rural level. “We need village-level programmes to address this issue . We also need to set up an efficient feedback system,“ he said.